It takes some pluck to drive in West Virginia, probably to live there, too, amid the many mountains, valleys, hills and “hollers.”
As one plucky experiment in open-source health information technology ends in the Mountain State, another continues to thrive.
I wrote about both recently: the seven-year test by a consortium of community health centers using a remote-hosted version of the Indian Health System's EHR, the Resource and Patient Management System, or RPMS, which is winding down; and the deployment in another network of the VA's VistA EHR across a couple of ambulatory-care clinics and seven state-run hospitals and long-term care facilities, a project that's going strong.
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It's fashionable these days to call every cluster of U.S. Senators a gang.
The Gang of Six. The Gang of Eight.
This week, six Republican senators, having formed their own grouping—let's call it the Gang of Carp—released what they called a “white paper.” In it, they carped about problems with the management and direction of several federal health information technology programs funded by the American Recovery and Reinvestment Act of 2009. They said we need to “reboot” the program, as if it had crashed. That assessment was unbalanced and unfair.
Also this week, a group of 10 healthcare IT cognoscenti—let's call them the Gang of Good Cheer—put out their own “discussion paper,” finding bliss in healthcare IT. Pangloss would have beamed at their grand vision of “an exponential rate of progress in the use of health and health-related data” as if there weren't serious shortcomings thus far. Their paper, too, was unbalanced; cheerleading bordering on euphoria.
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Here's a thought. When it comes to privacy and security, all patient information is equal.
This isn't a new idea, of course.
I have a copy of the Oath of Hippocrates on my wall. It says, “Whatever … I may see or hear … which ought not be spoken abroad I will not divulge, as reckoning that all such should be kept secret.”
In the U.S., however, that's all Greek to the feds and many states. They have created legal gradations of health information sensitivity. Patient information about mental health, drug and alcohol abuse treatment and HIV/AIDs, for example, is earmarked for special treatment, particularly when it comes to health information exchange.
Typically, U.S. laws specifically require patient consent before “sensitive” information can be shared, even between doctors and hospitals, whereas, under the 2002 HHS-revised HIPAA privacy rule, patient consent is no longer required for most data sharing of other health data types.
So, it was refreshing to visit with Dr. David Levin last week at a health IT leadership forum here in Chicago hosted by Microsoft.
“I'm a little bit of a contrarian,” said Levin, a board certified family practitioner and full-fledged geek doc. He is the chief medical information officer at the Cleveland Clinic.
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Before the release of the omnibus privacy rule earlier his year, or passage of the more stringent privacy provisions of the American Recovery and Reinvestment Act of 2009, or even the main federal health information privacy law, the Health Insurance Portability and Accountability Act of 1996, there were state, federal and common law provisions in full force about the handling of particularly sensitive patient information.
That special class of patient information includes patient records about treatment for drug and alcohol abuse, mental health, HIV/AIDs and sickle cell.
A workgroup of the federally chartered Health IT Policy Committee spent the better part of an hour Tuesday going over its recommendations on how to handle the legal and ethical privacy concerns over the exchange of digitized patient records. The gnarliest problem, evidenced by the longest discussion, related to the exchange of these particularly sensitive types of patient information, some with unique legal protections that are far more stringent than the rather lax restrictions under the current HHS interpretation of HIPAA.
Recommendations to the HITPC by its privacy and security tiger team, as the workgroup is officially called, were formally accepted for two of three classes of exchange. From there, they will be forwarded to the Office of the National Coordinator for Health Information Technology at HHS. The HITPC was created by the American Recovery and Reinvestment Act of 2009 to give such advice to the ONC.
Approved were recommendations on routine, “targeted” exchanges between providers with established relationships, exchanges in the paper world long since covered by HIPAA. In these transactions, after a 2002 HHS rewrite of the HIPAA privacy rule, patient consent is no longer required when the exchange occurs for treatment, payment and—this is where the laxity comes in—a host of “other healthcare operations.”
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Dear Jon Stewart,
I'm a huge fan of your “Daily Show,” but last week, with your segment, “The Red Tape Diaries,” you and your staff waded into the swamps of health information technology, made more dense and impenetrable by the Defense and Veterans Affairs bureaucracies.
By the sound of it, your hearts were in the right place, but you made a hash of a couple of things.
One topic covered by your segment was the alleged lack of interoperability between the VistA and AHLTA electronic health-record systems at the VA and DoD.
The other was the backlog of disability benefits claims at the VA, currently in excess of 900,000 claims and growing. A backlog, I might point out, that's exacerbated by the time it takes the Defense Department to round up and deliver to the VA all the medical records needed to document a service-related injury. It's a broken element that you didn't mention.
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A pair of new reports from the Office of the National Coordinator for Health Information Technology deserve your click-throughs.
Two surveys conducted with the help of the American Hospital Association show strong growth in overall electronic health-record adoption and substantial increases in literally dozens of key EHR functions. The reports cover the years 2008 through 2012.
The first report (PDF) focuses on growth in the percentages of EHR acquisition and adoption. It provides a state-by-state comparison of hospital “basic” EHR adoption rates. Some 14 states have achieved rates of 90% or higher, including Vermont and New Hampshire with 100%.
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I spoke with Dr. David Brailer last week and have been mulling over something he said ever since.
“The fight over the control of data will be an epic struggle,” he said. “I think it's going to be the reining battle of this decade.”
Brailer rephrased his statement to “a very large struggle” so as not to imply the fight will be between Judy Faulkner’s Epic Systems and everyone else, although the EHR wars are shaping up that way.
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Privacy, security rule update coming soon—honest.
The Office for Civil Rights at HHS is about to release its omnibus final rule on health information technology privacy and security—this time for sure.
“Stay tuned,” said Leon Rodriguez, director of the Office for Civil Rights, in a recent telephone interview. His office is the chief federal enforcement agency of privacy and security rules under the Health Insurance Portability and Accountability Act, and the lead rule writer for HHS of the HIPAA privacy and security rule amendments required under the American Recovery and Reinvestment Act of 2009.
“Stay really tuned,” Rodriguez said. “I would really watch closely in the coming weeks.”
But haven't we seen this movie?
Back in March 2012, the civil rights office shipped off its ARRA-mandated privacy and security rule update to the White House for what was then believed to have been only a perfunctory once-over by its Office of Management and Budget before its imminent release.
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Sometime before the end of March, the Office of the National Coordinator for Health Information Technology will be releasing new tools to help providers wanting to digitize the process of obtaining patient consent before releasing their medical records to regional or statewide health information exchanges.
The tools, developed in a pilot project in western New York, include educational videos that can be shown to patients on tablet computers, which also run software that enables patients to digitally record their consent (or not). The videos were developed following a random survey of western New Yorkers and several focus group meetings, with the aim of ascertaining what patients might want to know before they commit to making their electronic records available to the exchange.
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Private-sector healthcare leaders developing mobile health technologies should keep an eye on what's happening at the Veterans Affairs Department.
In April 2011, the VA and the Defense Department launched a stand-alone mobile application called PTSD Coach, a self-assessment tool and guide for people who have or who suspect they might have post-traumatic stress disorder. In its first 20 months, the app has been downloaded more than 90,000 times worldwide.
At the strong recommendation of a focus group of patients, PTSD Coach was designed to run without links to an electronic health-record system, with the idea being that more veterans and military personnel would seek treatment if, initially, they could anonymously download and use the tool for self-diagnosis.
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Private-sector healthcare leaders developing mobile health technologies should keep an eye on what's happening at the Veterans Affairs Department.
In April 2011, the VA and the Defense Department launched a stand-alone mobile application called PTSD Coach, a self-assessment tool and guide for people who have or who suspect they might have post-traumatic stress disorder. In its first 20 months, the app has been downloaded more than 90,000 times worldwide.
At the strong recommendation of a focus group of patients, PTSD Coach was designed to run without links to an electronic health-record system, with the idea being that more veterans and military personnel would seek treatment if, initially, they could anonymously download and use the tool for self-diagnosis.
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